Minimal access aortic valve replacement using a minimal extracorporeal circulatory system.

BACKGROUND

Minimal access aortic valve replacement (mAVR) has been demonstrated to be beneficial over standard median sternotomy. Similarly, minimal extracorporeal circulation (MECC) has been shown to have less deleterious effects than conventional cardiopulmonary bypass. We report a previously undescribed technique for AVR in combination with MECC by minimal access.

METHODS

We prospectively collected data including one-month postoperative follow-up of the first 50 patients who underwent mAVR utilizing MECC. A temporary Cordis Ventricor (Cordis Corp, Miami, FL) ventricular pacemaker and external defibrillation pads were placed at induction. A J-shaped partial upper sternotomy ending in the third intercostal space was performed. Cannulation was performed in the groin using the Seldinger technique. A vent was introduced directly in the pulmonary artery. Warm blood cardioplegia and carbon dioxide field flooding were used.

RESULTS

Fifty consecutive patients (24 male) with a mean age of 68 (range, 34 to 89) were operated between May and December 2007. Operating time was 147 +/- 20 minutes, cross-clamp time was 64 +/- 10 minutes, and perfusion time was 84 +/- 17 minutes. There were no conversions to median sternotomy. Only one peroperative blood transfusion was required and postoperative blood loss was 372 +/- 170 cc. Intensive care unit stay was uneventful (average stay 2 days, range 1 to 8). One patient required a permanent pacemaker and other complications included pneumothorax, superficial wound infection, a late transient postoperative neurologic deficit, and excessive postoperative blood loss requiring mediastinal reexploration. Renal failure and major cerebral accidents did not occur. There was a 100% survival at one-month follow-up.

CONCLUSION

We have shown that minimal access aortic valve replacement using minimal extracorporeal circulation is feasible and provides excellent clinical and cosmetic results.